Great Post and Podcast from Scott Weingart featuring Ashley Shreves on the practical steps to introduce these discussions in an ED setting.

End of Life Conversations are Hard

We stumble, we stutter, we say things that derail the discussion when we have a patient at the end of life. But how do we learn to do better? We model good behavior. But in order to do that we need to hear good discussions. I listened to Ashley Shreve’s amazing SMACC Chicago talk: What is a Good Death?

After listening, I wanted to bring Ashley back on to really get into the nitty-gritty of the semantics of End of Life discussions. Ashley has been on the EMCrit podcast before discussing Critical Care Palliation. Now lets hear from here again…

Tidbits I pulled out of the Podcast

The three patients that will spur Ashley to try to have these discussions:1. Advanced Cancer or Terminal Disease with Instability2. Advanced Frailty/Dementia with Instability3. Advanced Physiological Age (>85 y/o) with InstabilityStart with, “I’m so worried about your family member,” and see the responseThen, “Tell me how things have been going with your family member”Technique: Ask, Tell, Ask, TellKnow the trajectories of care for the diseases we deal withDoes that mean you will do nothing? No, we actually want to intensify the treatment, with a focus on peace and dignityWe don’t want to artificially prolong the dying processVitalists comprise 5-10% of the population, you are unlikely to convince these folks in the EDWhat if things don’t get better?